Effectiveness and Safety of Systemic Therapy for Psoriasis in Older Adults: A Systematic Review

Review (31 articles, n=39 561) found limited data per systemic agent, and overall quality of studies on conventional systemic therapies (CSTs) was low. Data indicated reduction of 75% in PASI at weeks 12 to 16 in 27% to 53% of patients on CSTs and 16% to 93% on biologics.

SPS commentary:

The review also noted that the scarce safety data suggest a higher chance of abnormal laboratory findings and (mild) infections in patients 65 years or older.


According to an editorial, this research serves as a helpful resource in treating patients with psoriasis of advanced age and disease; however, in addition to its clinical utility, it serves as a call to action by highlighting the lack of true data evaluating this population. It notes that although studies did show similar efficacy between older adults and younger cohorts for both systemic agents (methotrexate sodium, cyclosporin, and acitretin) and early-market biologics (etanercept, adalimumab, infliximab, and ustekinumab), the safety data remain scarce and difficult to interpret. Moreover, other common psoriasis medications have no data or nearly no data about safety and efficacy in aging populations, including secukinumab and apremilast.


The review is one of two articles in JAMA Dermatology, shedding light on the limitations of dermatology’s current understanding and research infrastructure for common diseases in older adults.


JAMA Dermatology

Resource links:


Review of inclusion of older adults in RCTs